Posts Tagged ‘dementia’

A recent Mayo Clinic study found a link between acting out dreams and the development of dementia. For details, see the following Mayo Clinic news release:

The strongest predictor of whether a man is developing dementia with Lewy bodies — the second most common form of dementia in the elderly — is whether he acts out his dreams while sleeping, Mayo Clinic researchers have discovered. Patients are five times more likely to have dementia with Lewy bodies if they experience a condition known as rapid eye movement (REM) sleep behavior disorder than if they have one of the risk factors now used to make a diagnosis, such as fluctuating cognition or hallucinations, the study found.

The findings were presented at the annual meeting of the American Academy of Neurology in San Diego. REM sleep behavior disorder is caused by loss of the normal muscle paralysis that occurs during REM sleep. It can appear three decades or more before a diagnosis of dementia with Lewy bodies is made in males, the researchers say. The link between dementia with Lewy bodies and the sleep disorder is not as strong in women, they add.

“While it is, of course, true that not everyone who has this sleep disorder develops dementia with Lewy bodies, as many as 75 to 80 percent of men with dementia with Lewy bodies in our Mayo database did experience REM sleep behavior disorder. So it is a very powerful marker for the disease," says lead investigator Melissa Murray, Ph.D., a neuroscientist at Mayo Clinic in Florida.

The study’s findings could improve diagnosis of this dementia, which can lead to beneficial treatment, Dr. Murray says.

“Screening for the sleep disorder in a patient with dementia could help clinicians diagnose either dementia with Lewy bodies or Alzheimer’s disease," she says. "It can sometimes be very difficult to tell the difference between these two dementias, especially in the early stages, but we have found that only 2 to 3 percent of patients with Alzheimer’s disease have a history of this sleep disorder.”

Once the diagnosis of dementia with Lewy bodies is made, patients can use drugs that can treat cognitive issues, Dr. Murray says. No cure is currently available.

Researchers at Mayo Clinic in Minnesota and Florida, led by Dr. Murray, examined magnetic resonance imaging, or MRI, scans of the brains of 75 patients diagnosed with probable dementia with Lewy bodies. A low-to-high likelihood of dementia was made upon an autopsy examination of the brain.

The researchers checked the patients’ histories to see if the sleep disorder had been diagnosed while under Mayo care. Using this data and the brain scans, they matched a definitive diagnosis of the sleep disorder with a definite diagnosis of dementia with Lewy bodies five times more often than they could match risk factors, such as loss of brain volume, now used to aid in the diagnosis. The researchers also showed that low-probability dementia with Lewy bodies patients who did not have the sleep disorder had findings characteristic of Alzheimer’s disease.

“When there is greater certainty in the diagnosis, we can treat patients accordingly. Dementia with Lewy bodies patients who lack Alzheimer’s-like atrophy on an MRI scan are more likely to respond to therapy — certain classes of drugs — than those who have some Alzheimer’s pathology," Dr. Murray says.

The study was supported by the National Institutes of Health/National Institute on Aging, the Harry T. Mangurian, Jr., Foundation, and the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer’s Disease Research Program of the Mayo Foundation.

Many older adults benefit from the friendship of a companion pet. Like people, pets are living longer these days which may help to explain why an Alzheimer’s-like syndrome (called cognitive dysfunction, or CD, in animals) is receiving growing attention from veterinarians and scientists. Writing for USA Weekend, Steve Dale recently reported on the issue:

Veterinary behaviorist Gary Landsberg of Ontario, Canada, is conducting research on CD in cats. Carl Cottman, director of Alzheimer’s Disease Research at University of California-Irvine, has investigated the disorder in both people and dogs. These researchers and other leaders in the field have learned that social interaction, physical exercise, enrichment (e.g., lifelong learning) and good diet appear to contribute to cognitive health in pets as well as in people.

Below are signs that CD may be present in a pet:

Disorientation/confusion;

Change in social interaction (e.g., withdrawal);

Sleeping disturbances;

Soiling in the house.

However, such problems could be caused by certain medical conditions like declining vision or diabetes, so veterinarians seek to exclude other medical explanations before settling on a diagnosis of CD. In some cases, CD and one or more additional health problems may be present.

The experts agree that both cats and dogs should be given regular physical exercise. One of the best steps (pun intended) canine lovers can take is to walk their dogs. Moderate exercise is good for the heart and good for the brain — and that applies to the pet and to his or her human companion alike.

Structured exercise and physical activity programs should be covered by insurance as a way to promote health and reduce health care costs, especially among high health-risk populations such as those who have diabetes.

So says Marco Pahor, M.D., director of the University of Florida Institute on Aging, in an editorial Wednesday, May 4, in the Journal of the American Medical Association. Pahor’s paper accompanies an analysis of multiple clinical trials that examined the effect of exercise and physical activity on the control of blood glucose levels.

“Cumulative work over the past few decades provides solid evidence for public policymakers to consider structured physical activity and exercise programs as worthy of insurance reimbursement,” Pahor said.

A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. People who take part in programs that contain both aerobic and resistance training are likely to get the greatest benefit, compared with people who do only resistance exercises.

The study that Pahor’s editorial accompanied, conducted by Daniel Umpierre, M.Sc., of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues, compared the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes.

Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

“People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

Various studies, including the UF Institute on Aging Lifestyle Interventions and Independence for Elders, or LIFE study, are aimed at answering those questions through randomized controlled trials that can provide data about the efficacy and cost-effectiveness of structured activity programs with respect to a range of health outcomes. Funded by the National Institute on Aging, the LIFE study is the largest of its kind to examine physical activity and health education as a way to prevent mobility disability among older adults, and accounts for the largest federal award to the University of Florida.

The institute will break ground on May 26 for a 40,000-square-foot complex within UF’s new $45 million, 120,000-square-foot Clinical and Translational Research Building, which will serve as headquarters for this research and others aimed at speeding scientific discoveries to patients.

“There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.

Leslie Alford, physiotherapist and lecturer at the University of East Anglia, conducted a research review of 40 scientific papers. Her summary of the key findings indicated that regular exercise can reduce the risk of many health conditions including heart disease, dementia as well as some forms of cancer. Ms. Abbott stated that “what is clear from the research is that men and women of all ages should be encouraged to be more physically active for the sake of their long-term health.” Please click below for a report from Science Daily.

Posit Science’s Karen Merzenich asks “what good is it to be 100 years old and physically fit if my mind is gone?” Her post, “Giving Health Advice for Older People? Don’t Forget the Brain,” appears in the Posit Science corporate blog where she suggests that “in aging, we need everything in our arsenal: the physical fitness, the diet, the friends and family, the shower bar, and unequivocally–the brain training.” Please click below for the complete post.

Ongoing research by the University of California-San Francisco, in cooperation with the USDA, is intended to discover more about the relationship between B vitamins and brain health. Current results have shown that lower levels of the B vitamin, folate, are “associated with symptoms of dementia and poor brain function.” Women participants with these lower levels also appeared to have a much greater predisposition for symptoms of depression. Click below for a report from USDA/Agricultural Research Service.

The American Senior Fitness Association (SFA) is pleased to offer special back-to-school savings on our Brain Fitness for Older Adults professional education program. Details on this time-limited opportunity are provided below. But first, here are the comments of two recent expert reviewers of the program:

Neuroscientist Dr. Ryan McKim: "Cognitive fitness and physical fitness are a natural fit. Drawing on recent neuroscientific research, the SFA has designed a thoughtful and progressive training program for senior fitness professionals interested in integrating cognitive fitness exercises into their existing physical activity programs. This powerful combination has the potential to make a significant impact on the health and well-being of older adults." Dr. McKim continues: "Recent advances in neuroscience are drawing long overdue attention to the importance of cognitive health. The SFA has designed an impressive and well-researched training program for senior fitness professionals."

Gerontologist Dr. Kathryn Thomas: "The SFA brain fitness materials gracefully strike the balance between rigorous research and practical, actionable information. The materials synthesize an enormous amount of research in a way that is manageable and enjoyable for the reader. I highly recommend the program to anyone wanting to get up to speed and actively involved in the brain fitness movement."

Ryan McKim, PsyD, is a clinical neuropsychologist specializing in the assessment of memory and cognitive rehabilitation. At San Francisco’s VA Medical Center, he is investigating neuroplasticity and developing novel strategies for veterans with traumatic brain injuries. Dr. McKim teaches neuropsychological assessment at the California Institute of Integral Studies and is vice president of research & outcomes at NeoCORTA Proactive Brain Fitness.

Kathryn Thomas, PhD, is a gerontologist whose research has been published in peer reviewed journals and presented at national conferences. Dr. Thomas is an adjunct professor at Georgia State University’s Gerontology Institute and is director of business development at NeoCORTA.

Call 888-689-6791 to take advantage of special savings on SFA’s Brain Fitness for Older Adults professional education program during our back-to-school event ending September 17, 2010. SFA office hours are 10:00 am to 5:00 pm ET weekdays. For ordering information, click on Special Savings. Be sure to sign in to receive your member discounts.

SFA, winner of the National Council on Aging’s Best Practice Award for professional education programs, can help you expand your older adult health-fitness services. For details about SFA’s Brain Fitness for Older Adults distance learning course — including selected excerpts from the text — click on Become a Cognitive Fitness Facilitator.

SFA president Janie Clark, MA, was interviewed earlier this year by Sandra Dias for her article Cognitive Fitness which appeared in Health Center Today, a publication of the University of Connecticut Health Center. Discussing two of many variables that can affect mental fitness, Clark said, "There is a connection between stress and depression and the state of one’s cognitive health. We teach the instructors and trainers how to integrate stress management and relaxation techniques into their classes." SFA helps health-fitness professionals guide their clients through a lifestyle approach to improving cognitive fitness. On a personal note, Clark added, "My own mom has dementia and we want to do what we can to prevent ourselves and our kids from going through that."

Others interviewed for the article included George Kuchel, MD, professor of medicine at the University of Connecticut School of Medicine and director of the UConn Center on Aging. One of the greatest boosters of cognitive reserve, he said, is lifetime education. As Dr. Kuchel explained and Dias reported: "Intellectual stimulation throughout life is now believed to build brain cells and improve connections between them. It appears that education acts as a buffer against cognitive declines associated with aging, as well as pathological changes." He said it is never too late to challenge the brain and that, in fact, it is critical.

In other news, while most Experience! readers are aware of the recent National Institutes of Health (NIH) expert panel report on preventing Alzheimer’s disease, broad access to thoughtful analysis of the project has been lacking. The independent NIH review did not find that specific interventions are proven to forestall the disease and, subsequently, some oversimplified interpretations of the endeavor have emerged in the media. Countering that course, we recommend examining useful commentary on the topic by Alvaro Fernandez of SharpBrains. Writing for the American Society on Aging (ASA), he cautions against drawing simplistic conclusions. For example, he asks and answers: "… does this mean that all recent news on the brain benefits of aerobic exercise are somehow unscientific? No, it doesn’t mean that." Elaborating, Fernandez notes that "… perhaps the most important take-away [is that] preventing Alzheimers … is a different outcome from improving cognitive fitness which, I would argue, is what most people care about …" To read this nuanced treatment of the matter in its entirety, click on ASA Article 1 and ASA Article 2. These links will open as PDFs.

Don’t miss out on this economical opportunity to further professionalize your senior fitness skills and services. Call 888-689-6791 to take advantage of special savings on SFA’s Brain Fitness for Older Adults professional education program during our back-to-school event ending September 17, 2010. SFA office hours are 10:00 am to 5:00 pm ET weekdays. To order on-line click on Special Savings. Be sure to sign in to receive your member discounts.

Here’s what recent graduates of the course are saying about SFA’s Brain Fitness for Older Adults professional education program:

"Lots of new information about keeping old brains young." -David, Georgia

"It was very thorough, clear and easy to follow the course outline. All aspects and materials included in the course were pertinent ‘knowledge-wise’ and of value ‘practice-wise’ … I REALLY enjoyed and appreciated what I learned (very positive and uplifting)." -Marie, Canada

"Many thanks for a wonderful course. The valuable information was clear, straightforward and in language I could understand — precise without being lofty. I currently teach yoga and tai chi, mainly to seniors. This course will enhance my own life and those of my students greatly. Thank you so much!" -Dixie, Georgia

"This course has brought a great deal of excitement to our program. Thanks!" -Mark, Texas

"This course started my interest in neuroplasticity, neurogenesis, and social intelligence plus play! I now have a library …" -Patricia, Florida

"The fact that I can implement cognitive and physical activities at once — this awareness is a lot more than I could ask for. Thanks." -Sandra, California

"Very enlightening and helpful to learn more about how the brain functions and what we can do to improve our cognitive fitness … Very glad I did this course. Thank you." -Diane, United Kingdom

"What I liked most was the review of brain anatomy and the multitude of suggested ideas for incorporating cognitive fitness." -Jeanne, Kansas

"I found it very informative. I liked the suggestions for incorporating brain fitness into exercise routines. Some of the content is very scientific …" -Debra, Florida

The tragedy of Alzheimer’s disease is exacerbated by tardy detection, especially since newly developed medications work better when started early. This problem inspired Dr. Douglas Scharre, a neurologist at the Ohio State University (OSU) Medical Center, to design a quick and simple test to help determine if someone is exhibiting the early memory and reasoning deficits that all too often foretell the onset of Alzheimer’s disease.

In an OSU press release, Dr. Scharre (who specializes in treating Alzheimer’s) said it is often more than three or four years after symptoms of cognitive impairment first begin to appear before he sees affected patients. "People don’t come in early enough for a diagnosis, or families generally resist making the appointment because they don’t want confirmation of their worst fears," he said.

Scharre’s test is called the Self-Administered Gerocognitive Examination (SAGE). Research shows that 80 percent of persons with mild thinking and memory issues will be detected by the test, and 95 percent of those with normal thinking will achieve normal SAGE scores.

While other accurate assessment instruments for cognitive disorders are presently in use, SAGE offers a number of advantages. Available cost-free to health workers, it only requires a paper, pen and about 15 minutes to self-administer. Therefore, it can be taken in the waiting room before seeing one’s doctor, doesn’t take much time away from medical staff or from the appointment itself, and is user-friendly for elders who are not comfortable with computers.

Abnormal scores can alert physicians to look for problems other than dementia, such as certain thyroid conditions, that can affect memory — and that may be treatable and reversible. Dr. Scharre added: "Abnormal test results can serve as an early warning to the patient’s family. The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators."